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The pulse characteristics of Ge (Reed) pulse are wiry, large, and rapid. Upon light palpation, it feels rigid; upon heavy pressure, the center is empty. Kou (Hollow), Lao (Deep-firm), and Jin (Tight) pulses all belong to this category. They differ from Jin pulse, which feels like striking a drum when pressed; from Xian (Wiry) pulse, which remains fixed in position when pressed; and from Lao pulse, which becomes harder upon pressing. (This passage is attributed to Zhang Lu. Additionally, Li Shizhen's poem in *Binhu Maixue* states: "Ge pulse feels like pressing on a drumhead, combining Kou and Xian qualities, indicating cold and deficiency; women may experience miscarriage or metrorrhagia, while men may suffer from Ying blood deficiency or nocturnal emission.") Ge pulse symbolizes transformation. It occurs in cases of blood loss or essence depletion, internal exhaustion of Kidney Qi, or the interplay of deficiency and cold, resulting in a lack of softness and an empty center. If one fails to tonify the Kidneys and replenish essence, soothe the Liver Wood, and dispel cold, but instead misinterprets the floating nature of Ge pulse as an exterior syndrome and recklessly uses ascending and dispersing methods, true Yin will likely be exhausted. (Zhang Zhongjing stated: "Xian indicates cold, Kou indicates deficiency. The interplay of cold and deficiency is named Ge pulse. In men, it manifests as blood loss or essence depletion; in women, as miscarriage or uterine bleeding." The Classics state: "If the pulses in all three positions are Ge, patients with chronic illness will die, whereas those with acute illness may survive.")

Lao pulse is characterized by being wiry, large, and long. Upon heavy pressure, it feels rigid and forceful against the fingers, resembling a string. Shi (Solid), Fu (Hidden), Xian (Wiry), and Se (Choppy) pulses fall into this category. They differ from Shi pulse, which is slippery, solid, and smooth; from Fu pulse, which is hidden and choppy, difficult to detect; and from Ge pulse, which is empty in the center upon heavy pressure. (This passage is attributed to Zhang Lu. Li Shizhen's poem notes: "Wiry, long, solid, and large, the pulse comes firm; Lao pulse usually resides between Shen and Fu positions. Ge pulse arises from the combination of Kou and Xian at the superficial level; one must carefully distinguish between the deficiency of Ge and the excess of Lao." Shen stated: "Resembling Shen and Fu, this is the location of Lao; solid, large, wiry, and long, this is the form of Lao. Lao pulse must not be confused with Shen or Fu pulses; careful differentiation is required. Shen pulse is like sand wrapped in cotton—firm inside, soft outside—but does not necessarily combine with large or wiry qualities. Fu pulse is not visible unless pushed to the bone. In contrast, Lao pulse, possessing solid, large, wiry, and long qualities, feels fully powerful under the fingers upon heavy pressure, serving as the distinction.") Lao pulse signifies deep-seated accumulation and is a sign that Stomach Qi is about to perish. (Wu Caolu stated: "Lao indicates cold-excess, while Ge indicates deficiency-cold.") Consequently, it may manifest as stiffness and urgency due to dampness, sudden reversal of cold hernia, or deep-seated hard accumulations, making treatment very difficult. If the underlying cause is not examined, and Lao pulse is mistaken for interior excess, leading to the use of bitter-cold herbs, or if dietary indulgence due to appetite causes stagnation, the disease will become more entrenched. (Li Shizhen stated: "Lao governs cold-excess diseases; Liver Wood excess leads to pain. Bian Que said: 'Soft indicates deficiency, Lao indicates excess.' In cases of blood loss, the pulse should be deep and fine; if it reverses to floating, large, and Lao, it is a death omen, representing an excess pulse appearing in a deficiency condition." Zhang Zhongjing stated: "Cold makes the pulse firm/secure," implying solidity.)